Provider Demographics
NPI:1306022835
Name:JAY CALESNICK, MD
Entity Type:Organization
Organization Name:JAY CALESNICK, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-935-0700
Mailing Address - Street 1:261 ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2023
Mailing Address - Country:US
Mailing Address - Phone:856-935-0700
Mailing Address - Fax:856-935-8630
Practice Address - Street 1:261 ROUTE 45
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2023
Practice Address - Country:US
Practice Address - Phone:856-935-0700
Practice Address - Fax:856-935-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03905900332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0353680001Medicare NSC